- Challenges reaching out to the male population and discussing male cancers
- Risk factors for male cancers including prostate cancer, testicular cancer and penile cancer
- Signposting to support and information on male specific cancers
Each year around 43,000 men will be diagnosed with a male specific cancer; over 41,000 with prostate cancer, more than 2,300 with testicular cancer and approximately 500 with penile cancer.
Research has indicated that men are 20% less likely to use primary care services than women and when dealing with the potential symptoms of a male cancer there are several other factors which may delay a diagnosis at an early stage.
For instance with prostate cancer and contrary to popular belief, the majority of men will have no obvious symptoms. This is because most prostate cancers will occur in the peripheral zone of the prostate away from the urethra and therefore urinary symptoms will not usually become apparent until the disease has progressed to cause them. Urinary effects such as lower urinary tract symptoms (LUTS) tend to occur much more commonly as a result of benign prostatic hyperplasia (BPH).
Testicular cancer is the most common cancer in men between the ages of 15-45 with 47% of men diagnosed under the age of 35. In 80% of cases there may be no associated pain or discomfort and unless men are performing regular and accurate testicular self-examination (TSE) they may fail to spot the possible warning signs.
With penile cancer the chance of men identifying and acting on possible symptoms is even less likely. They are unlikely to discuss penile health amongst their peers or their partners and most will have little or no knowledge of penile cancer in the first place. This is further complicated by the fact that being such a rare cancer, when men do come forward, their healthcare professional may never have seen a case of penile cancer during their career and may not be able to identify it. In this situation men may spend weeks or months receiving treatment for conditions such as balanitis or dermatological disease, therefore delaying diagnosis and treatment rather than being referred to a urologist for further assessment.
A Combined Approach
With so many changes occurring within the NHS and primary care setting it is likely that national charities such as Orchid will work more closely in the future with healthcare professionals both to raise awareness and provide support for local initiatives.
Healthcare professionals should also familiarise themselves with several key points specific to male cancer when focusing on such awareness and utilise the awareness tools and resources that charities such as Orchid have created.
Men who are more at risk of prostate cancer and who will often have a poorer prognostic outcome are men of African-Caribbean descent. Men of this ethnicity are three times more likely to develop prostate cancer and twice as likely to die from it. These men are more likely to be younger when diagnosed and have more advanced disease when compared to Caucasian men.
Men typically in their late 40s and early 50s with a strong familial history of prostate or female breast cancer (BRCA 1 or 2) in their families are also more at risk. Healthcare professionals should try to identify these men whenever possible, for instance when reviewing them for other non-related medical conditions. They should be given accurate information and counselled on the limitations of prostate specific antigen (PSA) blood testing and its possible implications. A digital rectal examination (DRE) which can often identify potential prostate cancer should be offered if they are felt to be at high risk.
Orchid has created an informative fold out wallet sized Z-Card raising awareness of these issues.
According to a recent survey of 3,000 men by Orchid, 82% felt that testicular cancer awareness had increased over the last five years. However despite this promising statistic, over two thirds of the men questioned were not confident in checking themselves for signs of the disease. The survey also revealed that single men were less likely to identify possible signs of testicular cancer while office workers were least likely to check themselves regularly and manual workers were more likely to ignore signs and symptoms.
Even when men notice an abnormality they are often reluctant to tell anyone or see their GP due to embarrassment or fear of what further investigation may reveal. In fact only a third of men would be willing to tell their partner or mother if they found a lump, the very people who are more likely to be able to persuade men to do something about a possible problem, according to the survey results.
Charities such as Orchid must continue to promote awareness of testicular cancer and encourage men to get themselves checked. In the past year Orchid have distributed more than 75,000 ‘ball basics’ - fold out Z-Cards which combine testicular trivia along with information on signs and symptoms of testicular cancer and how to perform TSE. These have been sent to schools, colleges and health professionals throughout the country and are regularly stocked by Macmillan information offices.
In 2012 Orchid launched an interactive microsite, at
www.yourprivates.org.uk, specifically to act as a central starting point for anyone affected by testicular cancer. This incorporates information and videos on all aspects of testicular cancer awareness and treatment. Earlier this year, to compliment the site, Orchid created a downloadable School Resource Pack which has been Personal Social Health and Economic Education accredited. This includes a video embedded learning PDF with a teachers lesson plan and quiz.
GPs should be willing to see men who identify a potential problem on an urgent basis or at short notice and if needed request an ultrasound of the scrotum for further evaluation. Although the majority of conditions will inevitably turn out to be non-cancerous this is the easiest way to reduce future anxiety. It is also likely that men who feel listened to and investigated promptly will be more likely to encourage friends or work colleagues to come forward if they are experiencing similar problems.
Although this is the rarest of all the male cancers it is potentially the most devastating. In the UK nearly all treatment will involve surgery, where possible to preserve the penis. The longer a problem is left the more extensive this surgery will be and the more psychologically damaging it will become. Any man who presents with a penile lesion or abnormality which does not improve using topical treatment or antibiotics (for treatment such as Sexually Transmitted Infections) within two weeks should be referred urgently to a urologist. A urologist will have more experience of identifying penile cancer and can arrange a penile biopsy or circumcision as a matter of urgency. Urology teams can also initiate a referral to the local penile supra-network for specialist assessment and treatment.
Orchid is currently in the process of creating an online GP learning tool to help healthcare professionals manage a potential diagnosis of penile cancer more effectively. A penile health Z-Card is also in the process of being created.
Orchid Male Cancer Information Nurse Specialists
0203 465 6105
1. RCGP. Curriculum 2010, revised 14 August 2013 : Statement 3.07. Men’s Health.
2. Cancer Research UK. Available at: www.cancerresearchuk.org
3. NHS Choices. Symptoms of prostate cancer. Available at: www.nhs.uk/Conditions/Cancer-of-the-prostate/Pages/Symptoms.aspx
4. Orchid 2014 Awareness Week Survey.
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